Methotrexate and histologic hepatic abnormalities: a meta-analysis.

@article{WhitingOKeefe1991MethotrexateAH,
  title={Methotrexate and histologic hepatic abnormalities: a meta-analysis.},
  author={Quinn E. Whiting-O'Keefe and Kenneth H. Fye and Kenneth Sack},
  journal={The American journal of medicine},
  year={1991},
  volume={90 6},
  pages={
          711-6
        }
}
STUDY OBJECTIVE To determine the risk of liver toxicity from the long-term administration of methotrexate in patients with rheumatoid arthritis or psoriatic arthritis. DESIGN A meta-analysis of 15 studies examining the relationship between long-term, low-dose methotrexate administration and biopsy evidence of liver fibrosis. PATIENTS A total of 636 patients from 15 studies. RESULTS The incidence of progression of liver disease (defined as worsening of at least one grade on the histologic… Expand
The long-term effect of methotrexate therapy on the liver in patients with juvenile rheumatoid arthritis.
TLDR
Long-term use of methotrexate for JRA does not appear to be associated with the development of significant liver fibrosis, and a prospective study of a larger population will more accurately define the incidence of MTX-related Liver fibrosis and appropriate monitoring guidelines in JRA. Expand
The relationship of hepatotoxic risk factors and liver histology in methotrexate therapy for juvenile rheumatoid arthritis.
TLDR
Serial biochemical abnormalities are significantly associated with Roenigk grade and the presence of liver fibrosis, suggesting that guidelines for monitoring MTX hepatotoxicity in rheumatoid arthritis may be applicable to patients with JRA. Expand
Risk and management of liver toxicity during methotrexate treatment in rheumatoid and psoriatic arthritis: a systematic review of the literature.
TLDR
It is suggested that LE elevations during MTX therapy are a frequent but transient problem, that serial abnormal LE tests might be associated with liver pathology, but that cirrhosis is relatively rare. Expand
Rare incidence of methotrexate-specific lesions in liver biopsy of patients with arthritis and elevated liver enzymes
TLDR
MTX-specific liver lesions are rarely observed in arthritis patients under long-term MTX therapy and elevated liver enzymes, reflecting shorter treatment duration due to liver abnormalities. Expand
Hepatic effects of long-term methotrexate use in the treatment of inflammatory bowel disease
TLDR
Cumulative methotrexate doses up to 5410 mg given up to 281 wk in patients with inflammatory bowel disease are associated with little hepatotoxicity, and surveillance liver biopsies based on cumulative methotRexate doses are not warranted in these patients. Expand
Changes in Liver Biochemistry During Methotrexate Use for Inflammatory Bowel Disease
TLDR
Methotrexate is commonly associated with LET abnormalities, but these frequently normalize while still on therapy, and in only 5% will drug discontinuation be necessary. Expand
Role of liver function tests in detecting methotrexate-induced liver damage in sarcoidosis.
TLDR
There is no difference between groups for levels of alkaline phosphatase and asparate aminotransferase at the time of starting (or restarting) methotrexate therapy, but there is a significant difference for liver function tests performed for those whose biopsy findings showed sarcoidosis. Expand
Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research
TLDR
This systematic literature search on MTX monotherapy with relatively low-dose use during at least 2 years shows favourable long-term safety of methotrexate monotherapy in rheumatoid arthritis. Expand
Liver fibrosis in patients with psoriasis and psoriatic arthritis on long-term, high cumulative dose methotrexate therapy.
TLDR
Monitoring for hepatic fibrosis using serial liver function and ACR guidelines tests alone as in RA appears safe in psoriasis and PsA and Liver biopsy ought to be considered to assess the liver if LFT are persistently elevated. Expand
Light and electron microscopic analysis of liver biopsy samples from rheumatoid arthritis patients receiving long-term methotrexate therapy
TLDR
RA patients present with liver damage before treatment with MTX, and at low doses MTX treatment is safe, though EM was more sensitive than LM for the detection of fibrosis. Expand
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References

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Liver histology in rheumatoid arthritis patients receiving long-term methotrexate therapy. A prospective study with baseline and sequential biopsy samples.
TLDR
It is concluded that long-term MTX therapy in rheumatoid arthritis patients results in a statistically significant worsening in hepatic histologic grade, with common development of mild fibrosis. Expand
Histopathologic findings in the liver of rheumatoid arthritis patients treated with long-term bolus methotrexate.
TLDR
The premise that prolonged administration of oral MTX, when given as a weekly bolus at a low dose, does not cause cirrhosis or severe fibrosis in the rheumatoid arthritis patient who does not abuse alcohol is supported. Expand
Prospective analysis of liver biopsies before and after methotrexate therapy in rheumatoid patients.
TLDR
The data indicate that pretreatment biopsy is unwarranted in a population similar to the authors', and the recommendation that RA patients have liver biopsies after 1,500 mg of methotrexate (a holdover from the psoriasis literature) may be too conservative in low-risk RA patients, provided metotrexate is administered weekly and alcohol is prohibited. Expand
Methotrexate and the liver.
TLDR
It was showed that isolated elevations of the aminotransferase enzymes or alkaline phosphatase levels did not predict liver disease, nor did the absence of elevation of these enzymes assure the presence of liver disease. Expand
Methotrexate-associated hepatotoxicity: retrospective analysis of 210 patients with rheumatoid arthritis.
TLDR
Although the prevalence of methotrexate hepatotoxicity in this large cohort of patients with rheumatoid arthritis was low, a small but definite risk of hepatic fibrosis, not predictable by laboratory screening, still exists. Expand
Hepatotoxicity of prolonged methotrexate therapy for rheumatoid arthritis.
TLDR
At these low dosages, MTX exerts a minor and clinically unimportant hepatotoxic effect during two to eight years of chronic maintenance therapy. Expand
Liver biopsies from psoriatics related to methotrexate therapy. 3. Findings in post-methotrexate liver biopsies from 160 psoriatics.
  • A. Nyfors
  • Medicine, Biology
  • Acta pathologica et microbiologica Scandinavica. Section A, Pathology
  • 1977
TLDR
Comparison of a material A and B indicates that the prevalence of cirrhosis and fibrosis among MTX treated psoriatics increases rapidly beyond a cumultative dose of two to four grams of MTX. Expand
The safety and efficacy of the use of methotrexate in long-term therapy for rheumatoid arthritis.
TLDR
Toxicity was noted at some time in 26 of 29 patients (90%), but reactions universally became mild and tolerable after adjustment of the dosage, and there was a significant reduction in mean prednisone dosage. Expand
Long-term prospective trial of low-dose methotrexate in rheumatoid arthritis.
TLDR
It is indicated that methotrexate has remained effective over 36 months of therapy, with acceptable toxicity levels and no evidence of systemic immunosuppression. Expand
Hepatotoxicity of methotrexate in the treatment of psoriasis.
Fifty patients with psoriasis were evaluated prospectively and retrospectively for possible hepatotoxicity from methotrexate therapy. Liver function studies were not reliable indicators of pathologicExpand
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